St. Luke’s and its physicians and staff believe in the basic principle of patient self-determination and the rights of competent adults to make their own medical treatment decisions and to execute Advance Directives.

Advance Directives are documents that allow individuals to make their wishes known in advance regarding end-of-life care and whom they want to make health care decisions for them if they should ever become unable to speak for themselves.

In keeping with the values and mission of St. Luke’s, and to the extent permitted or required by law, St. Luke’s physicians and staff will honor and comply with the terms of a patient’s Advance Directives in the inpatient and outpatient hospital setting, as long as the necessary physician orders are in place.

Note: Even if a patient has properly-executed Advance Directives, a current physician “Do Not Resuscitate” order (DNR) or Physician Order for Scope of Treatment (POST) is required in order to withhold resuscitative efforts. This order is written in the chart after the physician understands the patient’s wishes.

If a patient’s Advance Directives create medical, ethical, or professional dilemmas among physicians, family members, nurses, and/or other care providers, St. Luke’s Medical Ethics Committee, or a comparable medical staff committee, is available for consultation.

St. Luke’s will ask all patients who are 18 years of age or older and who are being admitted as inpatients to the Hospital, Hospice, or Home Care, whether or not they have Advance Directives and, if so, whether or not they wish to have a copy placed on their medical record.

Patients are not required to have Advance Directives, and St. Luke’s does not condition the provision of care or otherwise discriminate on the basis of whether or not Advance Directives have been completed. If you don’t have an Advance Directive on file, this information will be provided to you upon request. Patients are encouraged to discuss their wishes with their family members and their physician, and to complete Advance Directives prior to their admission.

Advance Directives - Important Definitions

Idaho Living Will:This document lets individuals state their wishes about medical care in the event they are terminally ill or in a persistent vegetative state and can no longer make their own decisions. The Idaho Living Will becomes effective immediately and is implemented when two doctors acknowledge that a person is terminally ill and that death will occur with or without the use of life-sustaining procedures or that they are in a persistent vegetative state.

Idaho Durable Power of Attorney for Health Care:This document lets individuals name someone to make decisions about their medical care – including decisions about life support – if they can no longer speak for themselves. This document is especially useful for individuals, because it appoints someone to speak for them any time that they are unable to make their own medical decisions, not only at the end of life.

Cardiopulmonary Resuscitation (CPR): A medical procedure, often involving external chest compression, administration of drugs, and electric shock, used to restore the heartbeat at the time of a cardiac arrest.Note: At St. Luke’s, as in many other hospitals, a current physician “Do Not Resuscitate” order (DNR) or Physician Order for Scope of Treatment (POST) is required in the chart in order to withhold resuscitative efforts. This order is written after the physician understands the patient’s wishes.

Artificial Life-Sustaining Procedure: Any medical procedure or intervention that utilizes mechanical means to sustain or supplant a vital function which, when applied to a qualified patient, would serve only to artificially prolong life. It does not include the administration of medication or the performance of any medical procedure deemed necessary to alleviate pain.

Artificial Nutrition and Hydration: Supplying food and water through a conduit, such as a tube or intravenous (IV) line, where the recipient is not required to chew or swallow voluntarily, but does not include assisted feeding, such as spoon feeding or bottle feeding.

Completing Advance Directives
Any competent person may complete a Living Will and Durable Power of Attorney for Health Care. A “competent person” is any person 18 years of age or older or any emancipated minor, as long as he or she is of sound mind. A person may cancel or revoke this document simply by issuing a new Living Will and Durable Power of Attorney for Health Care, or by writing or stating the wish that such document be cancelled or revoked.

The Idaho Living Will and Durable Power of Attorney for Health Care is easy to complete.

Individuals may complete the entire Living Will and Durable Power of Attorney for Health Care document, or they may just complete one part and leave the other part blank.

The Idaho Living Will and Durable Power of Attorney for Health Care does not have to be witnessed or notarized. It just needs to be signed by the person completing it.

Copies of the completed Living Will and Durable Power of Attorney for Health Care should be given to family members, physicians, hospitals, and others that may be involved in a person’s medical decision-making. Individuals should keep the original or a copy in a secure but accessible place.

Physician Order for Scope of Treatment (POST)
In addition to a Living Willing and Durable Power of Attorney for Health Care, patients may wish to request that their physician complete and sign a Physician Order for Scope of Treatment (POST) form.

The POST is a standardized form that allows a person to express his or her treatment wishes in advance of needing medical treatment. The POST is signed by your physician, and the orders on the POST will be followed by emergency medical personnel, medical care providers, and health institutions in the state of Idaho. Your physician may obtain a copy of the POST from the Idaho Secretary of State’s website at sos.idaho.gov, by clicking on “Health Care Directive Registry.”
For more information about the POST, please visit the Idaho Health and Welfare – Emergency Medical Services web page.

You may also have your POST placed in the State Health Care Directives Registry by following the instructions at the Idaho Secretary of State’s website at sos.idaho.gov, and clicking on “Health Care Directive Registry.”

TenFrequently Asked Questions

What Is an Advance Directive?

An Advance Directive is a document wherein you can give instructions about your health care if you can't speak for yourself due to injury or illness. A Health Care Directive is a type of Advance Directive that tells your doctor and your family members what kind of care you would like to have if you become unable to make medical decisions. It's called an "Advance Directive" because you choose your medical care before you become seriously ill or injured.

Advance Directives do not have to be complicated. They can be short, simple statements expressing your values and choices.

Examples of Advance Directives include Health Care Directives, Living Wills, Health Care (Medical) Powers of Attorney, and other personalized directives.

How is a Health Care Directive different from a Living Will?

Unlike most Living Wills, a Health Care Directive is not limited to cases of "terminal illness." If you cannot make or communicate decisions because of a temporary or permanent illness or injury, a Health Care Directive helps you keep control over health care decisions that are important to you. In your Health Care Directive, you state your wishes about any aspect of your health care, including decisions about life-sustaining treatment.

A Living Will is one form of Advance Directive. It usually only comes into effect if you are terminally ill. Being terminally ill generally means that you have less than six months to live. In a Living Will, you can say what kind of treatment you want in certain situations, but its use may be limited to situations when you are terminally ill.

A Health Care (Medical) Power of Attorney lets you name someone to make medical decisions for you if you are unconscious or unable to make medical decisions for yourself for any reason. A Health Care (Medical) Power of Attorney can be part of another Advance Directive form, such as a Health Care Directive or Living Will, or may be a separate document. The person you appoint, to make decisions for you when you cannot, is called an "agent".

Appointing an agent is particularly important. Should the time come when a decision needs to be made, your agent can participate in discussions with medical personnel and weigh the pros and cons of treatment decisions based on your predetermined wishes. Your agent can make decisions when you cannot decide for yourself, even if your decision-making ability is only temporarily affected.

Who Should Complete an Advance Directive?

Less than 25 percent of Americans have expressed their thoughts in writing about how they wish to be cared for if they become seriously ill or permanently injured or unable to communicate their choices for medical care. Most people avoid the subject. Each of us should discuss these issues so we can make informed choices in advance. Good choices now may ease the stress of our families, friends and other loved ones.

If I am healthy, why should I complete an Advance Directive?

When you are healthy, it's hard to think about the care you will want if you become ill or are facing the end of your life. But, when you are healthy, you are in the best position, physically and mentally, to make these decisions.

Aren't Advance Directives a legal tool for old people?

Not at all! Don't think of this as an "old" person’s issue. It may be natural to link serious illness with old age, but that is a mistake when it comes to Advance Directives. Consider that perhaps the most well known landmark court cases, such as those of Nancy Cruzan and Karen Ann Quinlan, involved individuals in their 20's. The stakes are actually higher for younger persons in that, if tragedy strikes, they might be kept alive for decades in a condition they would not want. An Advance Directive is an important legal planning tool for all adults.

Don't all Advance Directives mean, "Don't treat"?

While it is true that most people use Advance Directives to avoid being kept alive against their wishes when death is near, it is a mistake to assume that the existence of an Advance Directive means, "Don't treat." Advance Directives are also used to say that an individual wants all possible treatments. An Advance Directive is an opportunity to express your personal values and wishes for your future health care. Even when an Advance Directive limits life-sustaining medical treatments, you may wish to receive continuing pain control, comfort care and respect for your dignity.

Who does my Advance Directive Affect?

You and your family. If you have completed any form of Advance Directive, you still remain in control of you health care decisions as long as you are able to communicate your wishes. An Advance Directive, including a Health Care (Medical) Power of Attorney, has no legal effect unless and until you lack the capacity to make health care decisions or to give consent for care. If you are no longer able to make decisions for yourself, an Advance Directive can often relieve your family's stress. By expressing your wishes in advance, you help family or friends who might otherwise struggle to decide on their own what you would want done.

Your Doctors. Whether you are in good health or experiencing a chronic medical condition, each of your doctors should be your partner in developing an Advance Directive. Good health care decision-making requires good communication among all interested parties, and your physician is a key component of your health care plans. The contents of your written Advance Directive should reflect a continuing conversation between you, your doctor, family, and close friends.

Hospitals and other Healthcare Facilities. When you are admitted to a hospital or other healthcare facility, the staff must provide you with information about Advance Directives, offer you an opportunity to complete one, or collect copies of your previously completed Advance Directive. Doctors and other health care providers are legally obligated to follow your Advance Directive. However, in order to honor an Advance Directive, the physician or healthcare institution must be aware of it and what is says. It is up to you and those close to you to ensure that everyone who might need a copy of your Advance Directive in fact has a copy.

Emergency Medical Services - "911" People who are very ill, but living in the community, may face a challenge in having an Advance Directive followed if a crisis occurs and the emergency medical services (EMS) are called (for example, by calling "911"). EMS personnel are generally required to resuscitate and stabilize patients until they are brought safely to a hospital.

If you have completed any form of Advance Directive, you still remain in control of your health care decisions, as long as you are able to communicate your wishes. If you are no longer able to make decisions for yourself, doctors and other health care providers are legally obligated to follow your Advance Directive.

However, in order to honor an Advance Directive, the physician or healthcare institution must be aware of it and what is says. It is up to you and those close to you to ensure that everyone who might need a copy of your Advance Directive, in fact, has a copy.

Give a copy to the person you appointed as your decision-maker, also known as your health care (medical) power of attorney or Agent.

Give a copy to your family members and loved ones. Take the time to discuss your choices, values and preferences.

Give a copy to each of your physicians. You can take a copy with you on your next office visit. If you have a specialist that you do not visit often, mail one to the office address with a note asking for the document to be added to your medical record.

What Happens if I Do Not Have an Advance Directive?

If you do not have an Advance Directive and you cannot make health care decisions, the law gives decision-making power to default decision-makers or "surrogates." These surrogates, who are primarily family members in order of kinship, can make some or all health care decisions. In these situations, individuals risk having decisions made contrary to their wishes or by persons whom they would not choose.